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Biomedical subjects

D N Slater

Publications and source records attributed to D N Slater.

At least 73 records · Page 4Linked to original sources
PubMed1994

Epstein-Barr virus in cutaneous lymphomatoid granulomatosis.

Epstein-Barr virus (EBV) has been associated with various extra-cutaneous lymphoproliferative diseases and it has been suggested that EBV may have a similar aetiological role in the skin. In this study, 10 biopsies from 7 cases of primary cutaneous lymphomatoid granulomatosis have been analyzed, using in situ hybridisation, for the presence of EBV encoded RNAs (EBER-1 and EBER-2). Only one case showed positive staining with the EBER probes and it is concluded that, in the skin, the relationship between EBV and lymphomatoid granulomatosis is variable. The role of EBV as an etiological agent in primary cutaneous lymphomatoid granulomatosis appears less important than in primary respiratory disease.

Adolescent↗
PubMed1994

Audit of deaths from cervical cancer: proposal for an essential component of the National Screening Programme.

AIMS: To ascertain the type and relative frequency of major factors associated with deaths from cervical cancer. METHODS: Deaths from cervical cancer in Rotherham district for the period 1989-1991 were subjected to multifactorial audit by reviewing laboratory, hospital, and general practitioner records; together with, when appropriate, re-screening of cytology smears. This period represented the three to five years after a computerised National Screening Programme (NSP) had been implemented with a five year recall interval. RESULTS: Thirty six deaths were identified. The average age of death was 59 years with 39% occurring in those over 65. Only 6% of cases presented as a result of a cervical smear, comprising 3% derived from the NSP and 3% by chance. Forty seven per cent of cases in which the patient had died had no record of a previous smear invitation; 22% of patients were under 65 years and 25% 65 or over. Those under 65 had presented before the appropriate age band had been called. A non-response to a cervical smear invitation was identified in 22%. In 25% of cases a true negative smear had been reported one to eight years previously (average 4.8 years). An inappropriate laboratory diagnosis was identified in 17% of cases. Fourteen per cent represented false negative smears and 8% comprised inadequate smears that had been reported as negative. Inappropriate clinical diagnosis or management was identified in 19% of cases. In 22% two or more contributory factors were identified in the same patient. CONCLUSIONS: Areas highlighted by the audit warranting further attention included the targeting of women over 65 with no cytology record; those not responding to smear invitations; laboratory performance; clinical acumen; and the reasons for true negative cervical smears. Multifactorial audit of all deaths from cervical cancer should be advocated nationally to assess and improve the effectiveness of the NSP.

Age Factors↗
PubMed1994

Review of investigative diagnostic techniques for cutaneous lymphoma.

This article reviews the contribution of modern investigative techniques to the diagnosis of cutaneous lymphoproliferative diseases. Special attention is given to the significance of immunoglobulin and T-cell receptor rearrangements; as detected by Southern blotting and/or the polymerase chain reaction. Additional topics discussed include immunohistochemistry, cytogenetics, onco- and tumour suppressor genes and in-situ hybridization. It is recommended that the results of these techniques are interpreted in the form of a multifaceted diagnostic profile.

Blotting, Southern↗
PubMed1993

Metal deposition in post-surgical granulomas of the urinary tract.

Fourteen cases of post-surgical granulomatous inflammation of the urinary tract were studied to investigate the possible deposition in the tissues of metals derived from the diathermy instruments used. The granulomas showed central necrosis, palisaded histiocytes and giant cells. On electronmicroscopy both amorphous material and electrondense particles were seen in the granulomas. The former appeared to be necrotic tissue. The particles were metallic in nature. Energy dispersive analysis of X-rays showed the presence of tungsten, iron, copper, nickel, chromium, zinc and vanadium. Tungsten particles were always pure. Other single particles contained two or more of the remaining elements, indicating the presence of alloy metals. Analysis of the diathermy instruments showed the cutting loops to be pure tungsten and the 'rollerballs' to be nickel silver containing copper, zinc, nickel, manganese and iron. Both the loops and balls are supported on stainless steel wires containing iron, chromium, nickel, manganese, molybdenum, copper and vanadium. It is proposed that metallic fragments from the instruments were deposited in the tissues during the surgical procedures and elicited an immunological reaction with granuloma formation. Tungsten is probably inert but nickel, chromium, copper and zinc are immunogenic. Under certain circumstances both nickel and chromium may also be carcinogenic.

Aged↗
PubMed1993

Certifying the cause of death: an audit of wording inaccuracies.

AIMS: To audit wording and formulation inaccuracies in certifying the cause of death. METHODS: Five hundred causes of death were analysed from the counterfoils of medical death certificates (Form 66). Wording and formulation inaccuracies were defined as terms contrary to the notes given to doctors in books on death certificates. RESULTS: One or more inaccuracies were identified in 29% of cases. In 5.8% of cases, the inaccuracies were sufficiently serious to warrant further action or enquiry by the Registrar of Births and Deaths, including referral to Her Majesty's Coroner. CONCLUSIONS: Most inaccuracies could have been avoided by adhering to the notes for medical practitioners contained in books of death certificates. The wording and formulation of causes of death warrants special prominence in under-graduate and postgraduate medical education. The topic should be audited and medical practitioners should pay particular attention to cases worthy of referral to HM Coroner.

Cause of Death↗
PubMed1992

Cutaneous xanthogranulomatous inflammation: a potential indicator of internal disease.

Cutaneous xanthogranulomatous inflammation is usually regarded as a primary disease process. We describe two patients with xanthogranulomatous pyelonephritis and nephro-cutaneous fistulae, one patient with xanthogranulomatous cholecystitis and a chole-cutaneous fistula and one patient with xanthogranulomatous appendicitis and appendiceal-cutaneous fistula. After the first case, awareness that cutaneous xanthogranulomatous inflammation can be secondary to related internal disease played a vital diagnostic role in the subsequent cases.

Aged↗
PubMed1992

Sarcoidosis presenting with a granulomatous reaction confined to red tattoos.

A patient with sarcoidosis who presented with a granulomatous tattoo reaction is described. Although tattoo granulomata usually represent a local hypersensitivity reaction to tattoo pigments, they can be a manifestation of systemic sarcoidosis. In this case the lesions were confined to the red areas of tattoos suggesting that tattoo sarcoid may be more than just an example of the Koebner response.

Adult↗
PubMed1992

Diagnostic difficulties in 'non-mycotic' cutaneous lymphoproliferative diseases.

The diagnosis of cutaneous lymphoproliferative diseases is an area of bewildering complexity to many histopathologists. This article concentrates on 'non-mycotic' cutaneous diseases. The 'current state of the diagnostic art' is critically assessed. Cutaneous 'pseudolymphoma' is relegated to the position of an aid-memoire and is not a diagnosis. Inadequacies in the classification of cutaneous lymphoma are discussed and the non-specificity of many histopathological features is highlighted. The status of specific entities is analysed and the contribution of modern investigative techniques in diagnosis is evaluated. This includes cutaneous T-cell lymphomas with a detailed consideration of large cell lymphoma heterogeneity. Cutaneous B-cell diseases are shown to be an unresolved diagnostic maze and the necessity for new clearly defined diagnostic criteria is emphasized. Evidence is presented to show that many cutaneous lymphoproliferative diseases lie on continuous spectra that, initially, are probably antigenically driven, and that a diagnosis is best achieved by a multifaceted approach. This is exemplified by cutaneous diseases that have origins from both B- (cutaneous lymphoid hyperplasia/lymphoma) and T-cells (lymphomatoid papulosis, lymphomatoid granulomatosis and mycosis fungoides). The future diagnostic role of the polymerase chain reaction and cytogenetic analysis is discussed. Intriguingly, recent molecular evidence has shown that lymphomatoid papulosis, cutaneous T-cell lymphoma, CD30 positive large cell lymphoma and Hodgkin's disease can originate from a single T-cell clone and display an identical chromosomal translocation and T-cell receptor rearrangement. Careful clinico-pathological correlation combined with prolonged patient follow-up remains the gold standard for diagnosis.

Diagnosis, Differential↗
PubMed1992

The cyanide poisoning necropsy: an appraisal of risk factors.

Blood cyanide concentrations were measured in samples obtained from a pathologist before and after carrying out a necropsy on the body of a victim of cyanide poisoning. There was no significant increase in his blood cyanide concentration after carrying out the procedure. It is suggested that an important factor in determining the risk to those carrying out necropsies of the bodies of victims of cyanide poisoning is the amount of cyanide remaining in the stomach. There are several ways in which the theoretical risk inherent in carrying out such necropsies could be reduced, such as the use of a full face respirator, or the removal, intact, of the upper gastrointestinal tract to a fume cupboard for examination.

Adult↗
PubMed1991

Red tattoo reactions: X-ray microanalysis and patch-test studies.

Eighteen patients who developed cutaneous reactions to red tattoos were studied to identify the chemicals responsible for the reactions to modern red tattoo pigments. Biopsies from the tattoos were examined histologically and the chemical composition of the red pigments was analysed by X-ray microanalysis. A variety of metallic elements including aluminium, iron, calcium, titanium, silicon, mercury and cadmium were detected. Patch tests were performed to the relevant chemicals in nine cases, and only one patient reacted to mercury. This study demonstrates that although reactions to mercury still occur, other red dyes containing a variety of inorganic pigments may provoke a cutaneous inflammatory response.

Adult↗
PubMed1990

The size and number of bone marrow megakaryocytes in malignant lymphoma and their relationship to abnormalities in platelet count.

Platelet counts were measured routinely in 718 volunteer blood donors and 124 patients with malignant lymphoma. When considered by gender, the mean platelet counts of the patients with malignant lymphoma were significantly increased when compared to controls (P less than 0.01). In addition, 9% of males and 4% of females with lymphoma exhibited a thrombocytosis, in which their platelet counts exceeded the upper limit of the normal platelet count for control subjects (defined as 2 SDs in excess of the mean value). Megakaryocyte whole size, cytoplasmic and nuclear sizes, and megakaryocyte numbers were also quantified in bone marrow obtained from the iliac crest of 5 hematologically normal subjects and 26 patients with malignant lymphoma. Mean megakaryocyte sizes were significantly greater in subjects with lymphoma, when compared to control values (P less than 0.05). No significant differences in megakaryocyte numbers in bone marrow were observed between the two groups. For subjects with malignant lymphoma, platelet count was found to be significantly positively correlated with megakaryocyte size. The results of this study suggest that the elevated platelet count associated with malignant lymphoma is mediated by an increase in the size of the megakaryocytes in the bone marrow.

Adolescent↗
PubMed1990

A new filter technique permitting traditional histopathological assessment of fine needle aspiration specimens.

We describe a new filtration method based on a transport medium technique which allows histopathological assessment of the tissue fragments present in many fine needle aspirates. Fine needle aspiration cytology and biopsy preparations obtained from equally divided transport medium specimens were compared in a study comprising 104 palpable breast lesions and 29 other miscellaneous lesions. In general, fine needle aspiration biopsy provided better information on tumour origin and differentiation than fine needle aspiration cytology, particularly with systemic aspirates and those which were heavily bloodstained. In most instances fine needle aspiration biopsy also provided sufficient material to perform specialised staining and immunohistological techniques, and it is suggested that it may have a role in supplementing direct smear fine needle aspiration cytology in these areas.

Biopsy, Needle↗
PubMed1989

Nucleolar organizer regions in Spitz nevi and malignant melanomas.

Nucleolar organizer regions (NOR) are loops of DNA that transcribe ribosomal RNA; they can be easily identified in formalin fixed paraffin embedded tissue using a silver (Ag) method. It has been suggested that the number of AgNOR per cell can differentiate between benign and malignant melanocytic lesions of skin. We have studied 29 Spitz nevi (SN) and 39 invasive malignant melanomas (MM) by the same silver method. SN showed between 1.0 and 1.6 AgNOR per cell with a mean of 1.2. MM counts ranged from 1.2 to 4.2 with a mean of 2.0. It is concluded that the AgNOR method cannot reliably differentiate SN from MM; however, a count of more than 2.0 AgNOR per cell would favor a diagnosis of MM rather than SN.

Flow Cytometry↗